Streptococcus milleri groupと耳鼻咽喉・頭頸部感染症 Clinical Relevance of the Streptococcus Milleri Group in Head and Neck Infections

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著者

    • 藤吉 達也 FUJIYOSHI Tatsuya
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 吉田 雅文 YOSHIDA Masafumi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 宇高 毅 UDAKA Tsuyoshi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka
    • 田邊 忠夫 TANABE Tadao
    • 産業医科大学病院中央臨床検査部 Unit of Central Clinical Laboratory, University Hospital, University of Occupational and Environmental Health, Fukuoka
    • 牧嶋 和見 MAKISHIMA Kazumi
    • 産業医科大学医学部耳鼻咽喉科学教室 Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Fukuoka

抄録

<I>Streptococcus milleri</I> group (<I>S. constellatus, S. intermedius, S. anginosus</I>) は口腔等粘膜面の常在菌ながら, 全身の膿瘍性疾患や市中肺炎の起炎菌として近年注目されている. これらの菌種が, 各領域の感染症にどの程度の割合で分布しているのか, またその中に占める耳鼻咽喉科感染症の割合, 感染病態等は明らかにされていない. 耳鼻咽喉科感染症における本菌種の臨床的意義を明らかにするために, 過去3年間に当院で分離・同定された本菌種275株の由来診療科別内訳, 耳鼻咽喉科疾患の臨床像とその分離株に対する薬剤感受性を検討した. 全検出株の内訳は, 歯科 (19.6%), 内科 (17.1%), 耳鼻咽喉科 (16.0%), 外科 (15.6%), 産婦人科 (11.6%), 泌尿器科 (6.2%), 皮膚科 (5.8%), 脳神経外科 (4.0%), 小児科 (2.2%), 整形外科 (1.1%), 眼科 (0.8%) であった. 耳鼻咽喉科44株は42疾患から分離され, (1) 一般感染症として扁桃炎5例, 深頸部膿瘍4例, 副鼻腔炎4例, 先天性耳瘻孔感染3例, 歯肉膿瘍2例, 副鼻腔嚢胞2例, 扁桃周囲膿瘍1例, 化膿性耳下腺炎1例, 術後創感染1例, (2) 頭頸部癌治療に伴う感染症として術後創感染7例, 術後肺炎3例, 咽喉頭炎3例, 終末期肺炎3例, 再発巣部感染3例であった. 単独検出例は (1) 群60%, (2) 群26%, 同時検出菌は (1) では一般に病原性が強いと考えられている菌種は見られず (常在菌性のものがほとんど), (2) 群では日和見感染症に見られる菌種が多かった. 薬剤感受性はCCLとCTMに抵抗性を示す菌株が多く, ABPC, CPDX, CFDNにも感受性がやや劣る傾向であった. <I>S. milleri</I>groupは, 培養・同定方法の特殊性のためにこれまで一般臨床の場で見過ごされてきた可能性が大きい. しかし抗菌剤の普及に伴い, 常在菌叢と宿主免疫能との適正な関係が破綻する機会が増し, 本来は常在菌である本菌種が耳鼻咽喉科・頭頸部外科領域の重要な起炎菌の一つとなってきている可能性も否定はできない.

<I>Streptococcus constellatus, S. intermedius</I>, and <I>S. anginosus</I>, the 3 species of the <I>S. milleri</I> group, form part of the normal flora commonly found in the mouth, throat, and gastrointenstinal and genital tracts. This group has become known as an important pathogen in infections and abscesses, but data on the anatomical distribution of these species is lacking in relation to clinical significance.<BR>We obtained 275 strains of the <I>S. milleri</I> group from different departments at our hospital over the last 3 years, including 54 strains from dental surgery, 47 from internal medicine, 44 from otolaryngology (head and neck), 43 from surgery, 32 from gynecology, 17 from urology, 16 from dermatology, 11 from brain surgery, 6 from pediatrics, 3 from orthopedics, and 2 from opthalmology. The 44 strains from head and neck were found in 42 patients, -23 with primary infection and 19 with secondary infection induced by cancer treatments. The primary infection group included 4 deep neck abscesses, 1 peritonsillar abscess, 5 tonsillitis, 4 paranasal sinusitis, 3 congenital aural fistula infections, 2 dental infections, 2 paranasal sinus cysts, 1 supprative parotitis, and 1 postoperative wound infection. The secondary infection group included 7 postoperative wound infections, 3 postoperative pulmonary infections, 3 laryngitis and pharyngitis, 3 terminal pneumonias, and 3 infections of the local recurrence site. The <I>S. milleri</I> group was the only isolated organism in 13 cases (56.5%) of primary infection and in 5 (26.3%) of secondary infection. Among other organisms from the primary infection group, no so-called major pathogens were found. Antimicrobial susceptibility tests of the <I>S. milleri</I> group showed that 50% were resistant to CCL and 33% to CTM. ABPC, CPDX, and CFDN were also found to be less sensitive, although no resistant strains were detected.<BR>To adequately culture the <I>S. milleri</I> group, incubation in air containing carbon dioxide or in an anaerobic atmosphere is required, and differentiation of the 3 requires biochemical reactivity tests. Since not all facilities use identical techniques in routine bacteriological examination, a considerable number of the <I>S. milleri</I> group could be missed in unknown species of α-, β-, and γ-<I>streptococci</I> and culture-negative cases. With antibiotics now being used widely, normal flora such as the <I>S. milleri</I> group may have become an important pathogen in head and neck infections due to an imbalance between organisms and host defense.

収録刊行物

  • 日本耳鼻咽喉科學會會報

    日本耳鼻咽喉科學會會報 105(1), 14-21, 2002-01-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

参考文献:  44件中 1-44件 を表示

被引用文献:  8件中 1-8件 を表示

各種コード

  • NII論文ID(NAID)
    10008095348
  • NII書誌ID(NCID)
    AN00191551
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00306622
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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